An unofficial representative body has shared new guidance to ‘support’ GP partners in employing physician associates (PAs), warning that the use of ‘restrictive’ scope documents could result in legal challenge.
The new guidance, produced by United Medical Associate Professionals (UMAPs), advises on the qualifications, recruitment, prescribing powers and clinical supervision of physician associates.
Unlike the BMA and the RCGP’s scope of practice guidelines, UMAPs has said that PAs should ‘provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems’ in an example PA job description.
It claims to be a consolidation of ‘all known accepted literature’ regarding PA employment, and is much less restrictive than ‘scope of practice’ documents previously published by the BMA and the RCGP.
UMAPs criticised these documents, arguing that they have ‘been responsible for unlawful contract changes for PAs which have been successfully challenged’.
According to UMAPs chief executive Stephen Nash, his organisation has already dealt with 30 cases against GP practices over the last year where PAs have challenged ‘redundancies without proper cause and unfair dismissals’. He also claimed he was ‘aware of exponentially more’ cases not being handled by UMAPs.
Mr Nash told Pulse that ‘most’ of these cases are still ongoing but there have been ‘positive outcomes’ in some cases where practices ‘were able to maintain their physician associate workforce’.
Mr Nash said: ‘The BMA document was effectively in law a position stand from that organisation on what they think physician associates should do, and it was heavily restrictive […] it was very much a trade union position stand.
‘But then it was being pointed to [by GP practices] as reason for redundancy. It had no legal or statutory power and therefore it wasn’t an official document that they should use in that capacity.
‘Employers were welcome to look at it but it had no jurisdiction to say “this is what should happen”. So when that’s implemented it would then be grounds for unfair dismissal potentially, it was certainly a breach of contract.’
UMAPs is ‘not there to just callously go around suing GP partners’, Mr Nash told Pulse.
He said: ‘We absolutely do not want to be in legal dispute with GPs – we think they’ve been advised poorly, and it’s not their fault that they’re doing this. We are desperate to avoid conflict with them, but the guidance that they’ve been given is incorrect and is going to lead to that if they follow it.’
The new UMAPs guidance for employers, which was co-produced with the College of Medical Associate Professionals (CMAPs), states that the scope of practice for PAs is defined by their curriculum and after employment will ‘naturally evolve over time’.
It said: ‘A PA’s skill set is not limited to those obtained as a student. As a PA develops, so will their skills. These skills will vary between PAs as they evolve to fit the needs of their chosen specialty.’
In response to the UMAPs guidance, the RCGP told Pulse that its own scope of practice is ‘advisory’ and ‘aims to support GP practices and current employers of PAs’.
A spokesperson continued: ‘The College’s policy position to oppose a role for PAs in general practice was adopted at our September governing Council meeting.
‘However, there are around 2000 PAs already working in general practice and our guidance is intended to be a practical resource for their employers and to help provide clarity on how these roles are managed.
‘We have always been clear that it is for employers to decide whether to follow our guidance and that it is their responsibility to ensure the appropriate treatment and handling of existing PA contracts.’
Today, the BMA has threatened to move towards industrial action over the lack of a nationally agreed scope of practice for physician associates.
The union warned NHS England to urgently address the concerns of doctors in order to prevent any industrial action.
The GP Committee UK also recently voted in favour of ‘phasing out’ the physician associate role in general practice.
Earlier this year, UMAPs warned GP partners against implementing the BMA’s scope of practice of potential legal consequences.
This reads to me as unqualified practitioners do not understand their own limitations.
Practices already have patients seeing ACP Nurses, Practice Nurses, and HCA’s. While we have principles in place as to what is best for each to see, we do not have a fixed list that is unchanging from time of their qualifications as skill sets evolve, and people might still take some useful history or undertake some appropriate initial investigations. For example HCA might help a patient who suspects they have a urine infection test their urine and then inform other staff that an infection identified or advise patient they need to see a nurse or doctor. Indeed our HCA can talk to us as to what might be best approach to take to help address patient’s problem.
Do I think primary care is systematically underfunded and with funding losses restored we could employ more doctors more of the time ? Yes of course, and more prescribing ACP Nurses too. But until then “jobs for the boys” protectionist approach by RCGP and BMA seems naive and unhelpful to practices seeking ways to maintain access for patients.
What is needed is protect doctors’ time to cover for PAs, but not a rigid requirement for doctors to pre-triage every case and review every patient be personally reviewed before leave surgery. This does not happen with nurses seeing patients in A&E who do triage all walking cases themselves and pass on to casualty officers when required. Nor in primary care do I personally pre-vet every patient wanting to see our HCA for a BP review, nor double-check if they correctly advised what is a normal blood pressure and when they should be next reviewed, and PAs start with higher training level than HCAs. Surely staff are trained and they operate at their level of training and competency as that evolves over time. and refer across when required.
Come on David, there’s a bit of a difference between a HCA doing a BP check or a urine dip where they escalate any abnormal result of what’s a very simple procedure/task vs what Nash and UMAPs are suggesting.
They want PAs to see entirely undifferentiated patients at first contact and to only have to discuss when they feel they need to with their supervisor.
But time and time again, it comes down to who is responsible. PAs don’t have a regulatory body or professional registration and there isn’t a nationalised standard for the exams they sit.
Not to mention the salary banding is 2.5x higher than most HCAs
So, you can employ and deploy them as you please but there is no doubt that you as the supervisor are responsible for their actions.
This is not the same as ACPs as the exams are standardised and they have proper professional registration. You may be available for ACPs to escalate to, but if they don’t, you aren’t responsible for their consultations.
It’s time to stop fighting and start compromising.
-BMA/RCGP guidance effectively kills off PAs in Primary Care
-UMAPS make a stout defence of the PA role as originally intended and used internationally (e.g. USA)
What has happened has been a rush to employ PAs by both PCNs (ARRS scheme) and Practices unable to recruit doctors for many years.
PAs have been deployed in an uncoordinated fashion.
Yes it’s true, some Practices have used them as cheap “replacement doctors”, poorly supervised and medico-legally exposed.
But many Practices have successfully integrated PAs into their MDT, where they provide a brilliant service, supervised by GPs, working hard to maintain high standards of care for patients.
But rather than sort the wheat from the chaff, GP Representatives have caved to pressure from doctors struggling to find employment by effectively extinguishing an allied profession’s existence with their ludicrously rigid guidelines.
This is indeed Protectionism, and paints the deplorable picture of GPs hounding colleagues out of their jobs.
No wonder UMAPS is standing firm for the PAs they represent..
But rather than an ugly head-on collision, surely it’s time to broker a compromise deal.
Practices will need to demonstrate adequate supervision, presumably pay a premium to their medicolegal representatives, and crackdown on the cowboy Practices leaving PAs struggling alone without proper cover.
This would indeed make some Practices think twice about employing multiple PAs and try to recruit more GPs again, but give security to experienced PAs already established, with a narrower but clearer career pathway for the newly qualified
Some people think compromise is The Devil talking, but I consider it the only fair and balanced route out of this self-inflicted mess.
Thin end of the wedge. Protectionism & promoting “professional genocide” of PAs who have undergone approved training and have been valued members of the practice team is misguided & misplaced.
Exclusive tears for PAs by Partners and PCN CDs, while in another news Unemployed locum GPs relying on food banks, BMA council member warns. Hypocrisy at its best. Now PAs are essentially kicked out, some hypocrites are talking about compromise to keep back door open.
Re J S – you call me a hypocrite……really? Like many desperate GPs I hosed away endless thousands on unanswered adverts for replacement doctors as my partners left one by one, then, faced with an existential crisis, reluctantly took on a PA as second prize to stave off inevitable closure.
Yet now you want to callously throw thousands of PAs on the scrap heap. But just like the unemployed doctors you mention, PAs also have bills, mortgages, families to provide for. They were taken on in good faith with the prospect of a long career, but are now to be thrown to the wolves……no wonder their representatives are threatening legal action!
So my call for compromise is not based on hypocrisy, it’s a plea for fairness on both sides. By all means tighten up the regulations on PAs, restrict their numbers, improve their training etc (which will give new GPs a fairer shake to compete for more vacancies), but please respect that PAs are real people with real emotions, and simply putting THEM in the food bank queue instead of doctors is no victory.
Yes hypocritical. Here you are pointing the finger with “jobs for the boys” (err likely more girls actually) at the idea of the RCGP and BMA trying to protect the integrity and safety of medical practice whilst simultaneously arguing for protection of jobs for your mates – the guys you’ve invested so much in. The people you’re employing who “have mortgage’s too”. You feel their pain because you gave them a job. You have coffee with them each morning. I feel their pain too to be honest. This isn’t their fault. You dont feel too bothered by the pain of the better qualified GPs out there it seems. You never met them and you don’t share coffee with them. They aren’t your girls and boys. Responsibility for all this lies in funding yes but unfortunately it also with you. This is uncomfortable. You think its best to compromise. There is a difference between a fully qualified GP and the PA replacing them. It’s obvious and it’s not about protectionism. You’ve chosen to blur that all. I quite understand the moral dilemma that lead you here. But thats not a reason to keep it all going. I fear you are arguing for the continuance of a bad idea because you are knee deep. And I think I can see hypocrisy even if you don’t
They can have their own body to sue GPs but can’t have their own regulatory body and want to be regulated by the GMC? This is ludicrous
In my opinion the past difficulty in staffing with GPs has been used as a ruse by certain GPs to profiteer and although some find it annoying to keep referring to what I believe is the underlying cause of the disaster i.e. PCN CDs via PCNs (not all) profiteering to the extent of vast sums by employing ARRs, many of these GPs in more advanced stages of career place greed & personal profit before quality and standards at cost to both patients and their colleagues.
PCN CDs do not want this issue continually raised in order that the money and champagne continues to flow and would prefer it to remain concealed behind closed doors and from experience, the extraordinary backlash is extremely painful to experience and endure as I have when concerns are raised.
It is the greed of PCN CDs (not all) and certain GP partners in my view who have damaged the careers of not only their colleagues but also that of PAs as their greed for profit has taken precedence and led to this toxic environment which would have been avoided had correct standards been employed in the introduction of certain ARR roles from the outset as opposed to the benefit to the bank account of these PCN CDs and GP partners.
This stems from to a large degree with many of the same old faces hopping onto the PCN CD gravy train from their other board hopping from ICB,LMC , NHSE roles etc.
I am a partner and have seen the vast sums being received from PCNs and clearly using a PA to fill appointment slots would benefit the PCN CDs practice or GP partners practice from anywhere from a £25,000 to £50,000 (est.)saving per year. We have not used PAs and I can see the distress this group are facing but it is due to the greed of PCN CDs and certain GP partners who have led them to the abyss and no one else.
When partners and PCN CDs point fingers to others for the distress PAs are suffering I suggest they take a hard look at themselves, and their own personal gains or limited company gains as a first step as Pas could have been integrated into Primary Care had we not been led by some the clowns who take centre stage in the PCN circus (exceptions noted). If you are so concerned, the distress to out of work GP colleagues seems to have largely escaped these GPs attention.
Some PCNs have family members as part of the PCN i.e. networks within networks and the profits are potentially even greater for these connected individuals within PCNs.
Enhanced access has seen some PCNs paid £170 (approx.) per hour yet employ for example a HCA to undertake these sessions (unsure if PAs have ever been used in this way) at £15 to £20 per hour and even with on costs the GPs sitting at home pocket £120 per hour for literally doing nothing.
Let’s not fool ourselves, PCN CDs have led in my view the most outrageous staggering waste of Primary Care NHS resources in NHS living memory (maybe others can suggest worst examples) and although some have acted correctly and are not within this group, many need to be held formally to account for their actions and damage inflicted over the last 5 years or so.
Before PA’s find their feet in general practice , there is a union called UMAP!! They threatened to sue, not very attractive for gps to employ PAS..
Really hard to read doctors so blatantly attacking our NHS colleagues here. This is to me a sensible constructive response from PAs to two years of constant bullying by the doctors and their representative bodies. PAs have been in our health service delivering care since 2005, so some have decades experience in general practice. They are valued for their care and so are ANPs, HAs and receptionists( who believe it or not have to handle a lot of undifferentiated care decisions too). Sensible compromise please as this government moves services and resources into primary care and those areas that need it most ( where doctors don’t want to work much!).
I do not condone any unfair treatment of PAs, who are the victims of poor NHS workforce planning and policy-making. However, I’d like any GP defending the deployment of PAs to see undifferentiated illness to explain how this is safe, unless every consultation is reviewed in real time by a GP. The analogy drawn with HCAs above is bizarre – HCAs perform only tasks for which they have been specifically trained.
I can’t help but suspect that GPs defending the use of PAs to see undifferentiated illness are trying to normalise their own practice’s use of PAs, despite knowing in their hearts that it is unsafe.